Pharmacy, Austin Health, Heidelberg, Victoria, Australia
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open Qual. 2022 May;11(2). doi: 10.1136/bmjoq-2021-001768.
Managing medications inappropriately when patients have oral intake restrictions can cause patient harm. This study evaluated the impact of a medication policy separating fasting from nil by mouth with respect to giving oral medications in patients fasting before a diagnostic or interventional procedure.
The policy stipulated that 'fasting' means oral medications should be given with a sip of water up to 1 hour before a procedure, unless there is a clinical reason to withhold, while 'nil by mouth' means nothing to be given orally, including medications.The policy was implemented in Surgical areas in February 2015 and Medical areas in March 2015 at a tertiary referral hospital in Melbourne, Australia, and included bedside signs, clinical champions and education sessions.The study was conducted in 2020. Admission and medication records were matched for non-elective procedure patients from January 2014 to May 2016. The monthly proportion of doses omitted inappropriately and overall omissions pre/post-policy implementation were compared using segmented regression.
Pre-implementation, the proportion of doses withheld inappropriately and total omissions in medical areas were 18.1% and 28.0%, respectively. Post-implementation, an absolute reduction of 13.4% (95% CI 9.0% to 17.7%) and 11.1% (95% CI 2.6% to 19.6%), respectively, was seen. Post-implementation linear trend showed a 0.3% (95% CI 0.0% to 0.6%) increase in inappropriate omissions but not overall omissions.In Surgical areas, pre-implementation proportions for inappropriate and overall omissions were lower than Medical areas'. Post-implementation, there was an absolute decrease in doses withheld inappropriately (8.3%, 95% CI 0.8% to 15.7%, from 11.9% pre-implementation) but not total omissions.
Distinguishing fasting from nil by mouth appeared to provide clarity for some staff: a reduction in inappropriate omissions was seen post-implementation. Although the small increase in post-implementation linear trend for inappropriate omissions in Medical areas suggests sustainability issues, total omissions were sustained. The policy's concepts require verification beyond our institution.
当患者存在口服摄入限制时，不恰当地管理药物可能会对患者造成伤害。本研究评估了在诊断或介入性程序前禁食的患者中，将禁食与禁食分开的药物政策对给予口服药物的影响。
该政策规定，“禁食”是指在程序前 1 小时内，可以用水送服口服药物，除非有临床原因需要停药，而“禁食”是指不能口服任何东西，包括药物。该政策于 2015 年 2 月在澳大利亚墨尔本的一家三级转诊医院的外科区实施，并于 2015 年 3 月在医疗区实施，包括床边标志、临床拥护者和教育课程。该研究于 2020 年进行。从 2014 年 1 月至 2016 年 5 月，对非择期手术患者的入院和用药记录进行了匹配。使用分段回归比较了政策实施前后每月不恰当地遗漏剂量的比例和总体遗漏情况。
实施前，医疗区不恰当地停用药物的比例和总遗漏量分别为 18.1%和 28.0%。实施后，分别绝对减少了 13.4%（95%CI 9.0%至 17.7%）和 11.1%（95%CI 2.6%至 19.6%）。实施后的线性趋势显示，不恰当地遗漏的比例增加了 0.3%（95%CI 0.0%至 0.6%），但总体遗漏量没有增加。在外科区，实施前不恰当地遗漏和总体遗漏的比例低于医疗区。实施后，不恰当地停用药物的剂量绝对减少（8.3%，95%CI 0.8%至 15.7%，从实施前的 11.9%），但总体遗漏量没有减少。
将禁食与禁食区分开来似乎为一些工作人员提供了明确性：实施后不恰当地遗漏的情况有所减少。尽管医疗区实施后不恰当地遗漏的线性趋势略有增加，表明可持续性问题，但总体遗漏量保持不变。该政策的概念需要在我们机构之外进行验证。
